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New ideas in scoliosis treatment

The OFFICIAL response to “CLEAR Institute Complaints“.

New ideas are almost never readily accepted….even when they are good ideas. Many times new ideas are met with skepticism (understandably) and rejection, simply because it challenges the current conventional wisdom. The general public aren’t the only ones whom are prone to this “knee jerk” type reaction to new ideas. Many established “experts” in the field are quick to condemn new ideas without investigation and generally their condemnation is based off a “That isn’t the way we do things around here” [protecting their status quo] or “It wasn’t invented here” [protecting their egos] perspective. Most will hide behind the “evidence based medicine” (which, as a note of reference, I fully support) excuse, until it is undeniably pointed out that scoliosis brace treatment and scoliosis surgery have no evidence based medicine basis either, but that doesn’t stop them from recommending it to patients despite their extreme invasiveness and poor long-term outcomes.

None-the-less, many people feel the need to look for the negative attributes in new ideas and the CLEAR InstituteTMScoliosis Treatmenthas not been immune to this type of criticism, so I have written this hubpage to address 8 of the most common “CLEAR InstituteTMcomplaints” that I have come across thus far. I’m sure more will be added to the list in time.

The Cobb Angle is Only a “Symptom” of Scoliosis

Genetics + Environmental Factors = Scoliosis

1. No two scoliosis cases are the same.

“Every one’s scoliosis is their own” are the words of wisdom uttered repeatedly in Martha Hawes’ definitive scoliosis text book, “Scoliosis and the Human Spine“. These words were true when she first wrote them and they are every bit as true today.

Scoliosis is a multi-factorial condition that is the result of genetic pre-disposition and environmental factors that combine to cause the spinal curvature known as “scoliosis”.

Metaphorically, it could be described in terms of toothpaste being squeezed out of a tube. (see diagram to the right) The genetic pre-disposition would be the equivalent of how tightly the cap is screwed on; The environmental influence is how hard the hand is squeezing the tube; and the amount of toothpaste being ejected out of the tube is the resulting combination of both the cap tightness and the pressure from the squeezing hand.

With this understanding, it is self-evident that no two scoliosis cases/patients will ever have the same combination of genetic and environmental factors that are causing their scoliosis curvature and therefore no two scoliosis cases are necessarily comparable from a research or scoliosis treatment result comparison. Thus, the scoliosis treatment results from one case can not accurately be compared to the scoliosis treatment results/ treatment expectations of another patients case. No only does this make researching scoliosis treatment very difficult, but it also makes patient testimonials basically worthless. Indeed, “every one’s scoliosis is their own“.

CLEAR Institute: 21 year case follow up x-rays

2. Are the results Long Lasting?

One of the greatest hurdles facing CLEAR InstituteTM in the coming years is obtaining the necessary funding to pursue the long-term research into our technique, which is so desperately needed to establish confidence in the solidity & permanence of the achieved correction. It is an interesting side-note to point out at this time that, while the first spinal fusion surgery for scoliosis was conducted in 1911, and bracing has been around since the 17th century, many research reviews still consider the scientific evidence on these techniques to be inconclusive at best, despite the considerable resources wielded by the organizations advancing these techniques. CLEAR InstituteTM, by contrast, was established less than a decade ago, in 2000, and did not begin working with scoliosis specifically until 2003. Coupled with the fact that CLEAR InstituteTM is an organization primarily staffed by volunteers, most of them being clinicians who also maintain active private practices, it should be obvious that our financial & temporal resources are constrained to a much more significant degree.

Whist that being said, one of the greatest challenges to long-term research studies is that they take 20-25 years to complete and require HUGE sample sizes due to the number of study subjects that drop out of a long-term study or are disqualified for a multitude of reasons.

With that being said, the pre and post x-rays in the upper right hand corner demonstrate the long-term corrective value of many of the “pre-CLEAR InstituteTM” scoliosis treatment procedures that were being developed prior to CLEAR’s inception. This patient was treated from July 1976- July 1976 with a reduction in her Cobb angle from 22 to 2.5 degrees, before moving out of the area. Over 21 years later, she returned to the clinic and the re-evaluation x-rays show absolutely no curve what-so-ever despite receiving no treatment since 1976.

While this is only one case and in only a moderate degree curvature, it does show the potential of a neuro-muscular re-education based scoliosis rehabilitation program can have a positive long-term effect.

How much will your health insurance cover?

3. Is CLEAR Institute Scoliosis Treatment cost effective?

When you look at the cost of the CLEAR Institute scoliosis treatmentTM program, it certainly seems like a lot of money. If you call some of the CLEAR InstituteTM clinics, you’ll find out that the exact prices will vary, because each clinic sets their own prices. If you’re traveling from out of town for the intensive treatment (which is two visits each day, each visit lasting about 3 hours), most clinics charge around $3,000 for one week of care – not including the cost of travel, lodging, and food. Patients who live near a CLEAR InstituteTM clinic and receive care on a regular basis pay less, although the total cost will vary from person to person, depending upon the severity of the curvature and what treatment is required.

However, it’s not just about cost – it’s also about value. In order to understand why the treatment costs so much, you have to compare it to the other treatment options available.

With a mild case of scoliosis, the treatment fees for the CLEAR Institute methodTM are generally less than with a severe case of scoliosis. The other option besides CLEAR is doing nothing; observation only. However, even observation only has its costs – the cost of doctor visits, x-rays, and exams. According to research, the average cost of simply monitoring a mild curve for one year is $3,386.25, and the only benefit to observation is that you know what’s happening.1 There are no recorded cases of scoliosis being cured by observation.

Comparing one year of doing nothing to one week of intensive treatment, the cost of one week of intensive treatment is less. The potential benefits are walking away with a Cobb Angle that is less than what it was before (sometimes even less than 10 degrees, thus technically no longer considered a scoliosis), and knowing what exercises & therapies to do at home to maintain and improve upon the correction. If the patient does their exercises faithfully and the correction can be maintained until skeletal maturity, research has shown that the chance that the scoliosis will worsen in adulthood is drastically reduced.2 The real benefit of CLEAR Institute scoliosis treatmentTM, then, is that a person with a mild scoliosis may never need to worry about wearing a brace or undergoing surgery, or suffering pain or limitations because of their scoliosis later in life.

In this light, it really doesn’t make much sense why someone would choose to merely observe and do nothing about their scoliosis, when they could instead actually reduce the chances of their scoliosis getting worse – and pay less than if they chose to do nothing.

With a moderate case of scoliosis, scoliosis brace treatment is introduced as a treatment option. It must be recognized that the goal of scoliosis bracing is merely to stabilize a curve that is progressing; back bracing does not offer any long-term benefit or hope of correction. The cost of a scoliosis brace varies widely depending upon the design, but generally ranges from $5,000 to $10,000. This does not include the cost of the doctor fitting the brace, x-rays taken in the brace, or other associated fees – which, according to research, average around $10,836 annually.1 So a patient being orthopedically braced faces an initial investment of $5,000 or more, plus $10,000 each year they wear the scoliosis brace. If, at the end of the back bracing period, their curve has progressed 5 degrees, this is then considered a success???

It’s important also to consider the ramifications of wearing a scoliosis brace – the time involved, and the emotional impact. Back Bracing is typically recommended for 23 hours out of the day; compliance, understandably, has been shown to be very poor.3 The psychological trauma of wearing a scoliosis brace during the formative middle school or high school years can also be very real, and can leave invisible scars that last for a lifetime.4

The CLEAR InstituteTM method for scoliosis recommends that someone with a moderate case of scoliosis purchase a Scoliosis Traction ChairTM to use at home; this costs about $4,000. Generally they will use this chair twice a day for 30 minutes each time; one hour a day, instead of 23 hours. There’s no risk of emotional trauma; the chair is only used for a short time, not in a public setting but in the privacy of your own home, and you can watch television or play video games to help the time pass faster. If the scoliosis is corrected to the point where the Scoliosis Traction ChairTM is no longer needed, it can be sold back to the company and a portion of the initial cost is returned to you. This isn’t possible with a scoliosis brace, where each back brace is custom designed and fitted for one individual patient. Compliance with the chair tends to be much greater than it is with an orthopedic brace, because the time required is much less, and there is no shame or social isolation associated with using it.

A moderate case of scoliosis that travels to a CLEAR InstituteTM clinic from out of town may require two weeks of intensive treatment; this treatment regimen might be repeated again later on. The cost of two weeks of treatment averages around $5,000 (the initial examination is more expensive than later visits, so the cost is front-loaded). So, someone with a moderate case of scoliosis might be spending $10,000 a year on CLEAR Institute scoliosis treatmentTM – generally what they would be paying to undergo scoliosis brace treatment. They’ll be spending a little bit less on the Scoliosis Traction ChairTM than they would for a back brace.

The value of CLEAR InstituteTM scoliosis treatment in this case is as obvious as it is with a mild case of scoliosis. Instead of hoping for the curve to stay the same, you’re hoping for the curve to get better. The financial costs are similar, but the emotional costs are much less. Instead of being motivated by the fear that if you don’t wear your back brace, your curve will get worse, you’re motivated by the hope that if you use the chair every day, your curve will be much better. If you do, and it does, you are rewarded by being able to reclaim some of the money you spent on the Scoliosis Traction ChairTM.

With a severe case of scoliosis, surgery enters the picture. The cost of scoliosis surgery varies from region to region, but can be as high as $152,637.5 This does not include the cost of recovery time in the hospital, time lost from school or work – or the cost of revision surgery or treating any unforeseen complications. It should be expected that, when a healthcare procedure costs as much as a modest home, it has been thoroughly researched and proven to be effective. Unfortunately, only the first is true. There is no definitive long-term research that proves living with a fused, straight spine is superior to living with a flexible, curved spine. Each generation of new spinal implants evolved because of problems with the previous systems; these new systems allow better correction, but also result in a higher rate of complications. Whether it’s Harrington, Colorado, Cotrel-Dubousset, TSRH, or Universal Spine System, regardless of the type of instrumentation used, the underlying premise behind every spinal fusion surgery for scoliosis is identical; immobilization and solid bony fusion of the spine, resulting in a permanent loss of spinal flexibility and range of motion. There are never any guarantees that additional surgeries will not be needed, or that pain levels will be reduced or that cosmetic appearance will be improved by scoliosis surgery.

One of the primary goals of CLEAR InstituteTM scoliosis treatment is to ensure that the patient achieves the best possible quality of life and functions at the highest possible level. With scoliosis surgery, this is considered of secondary importance; the main goal is to make the spine look straighter on an x-ray. There is no correlation between this outcome and reductions in pain, improvements in lung function, increases in quality of life, or better physical function.

When an individual with severe scoliosis presents for CLEAR InstituteTM scoliosis treatment, it’s highly likely that the patient will be making a long-term commitment to care. Again, fees vary, but let’s imagine a hypothetical situation where a patient spends about $200 per visit, and comes in 50 times in one year. That patient would have spent around $10,000. If each visit is three hours, the hourly fee is just over $60 per hour – roughly the same fee that many massage therapists charge for an hour-long massage. This is a perfect example of how costs may mislead, but comparing the cost of one treatment to another – and what you should expect to receive for your money – leads to a better understanding of the real value of each therapy.

So while $10,000 may seem like a high cost, its value compared to surgical intervention is significant. One study found that 16.7 years after spinal fusion, 40% of patients were legally defined as permanently handicapped (it is rather ironic that scoliosis surgery is often presented as a patient’s only option to avoid permanent disability). Imagine you had a check for $150,000 that you had to spend only on healthcare, and ask yourself if you would choose to undergo an operation that may leave you worse off fifteen years from now, or spend your money on fifteen years of you & a CLEAR InstituteTM doctor working together to correct your scoliosis naturally.

Before anyone can fully accept this comparison, it’s reasonable at this point to ask, where is the long-term research on CLEAR’s methods? The cold hard truth is that, if there was any real interest on the part of the orthopedic community of finding a more cost-effective, less invasive method of helping people with scoliosis to lead active, pain-free lives without back bracing or scoliosis surgery, there would be extensive resources devoted to publishing this research. However, the vast majority of all scoliosis research done today is on the topic of surgical intervention; less than 5% of the articles published focus on finding alternatives or providing non-surgical alternatives. In the absence of the infrastructure & funding to implement a well-designed, independent study comparing CLEAR Institute scoliosis treatmentTM to scoliosis surgery, it is the responsibility of the patient to be their own advocate, and rely upon their own judgment, until such a time as when someone decides to put surgery to the test, and compare the long-term outcomes between surgically-treated patients with CLEAR InstituteTM-treated patients.

4. Is there any CLEAR Institute Scoliosis Treatment research?

Given the continual push for “evidence based medicine” (which once again, is a very good thing), it is necessary to publish clinic data that not only demonstrates a willingness for transparency with in the scoliosis treatment community, but also helps establish a “best practices” data pool for statistical comparison.

The first pilot study based on spinal manipulation and scoliosis exercise procedures was published on BioMed Central in 2004; it was the first study of its kind and to date is the most accessed study in website’s history. A direct link to the full study is available under the “BioMed Central” logo to the right of this section.

The results and conclusion of the study:

“After 4-6 weeks of treatment, the entire sample size averaged a 62% reduction in their Cobb angle measurements. None of the patients Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to the home care instructions, leaving 19 subjects to be evaluated post-intervention.”

“The Scoliosis Reduction and Rehabilitation Protocol appeared to markedly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol.”

In 2010, Drs. Will Kalla, A. Josh Woggon, and Dennis Woggon compiled clinical data on 140 scoliosis patients who under went CLEAR InstituteTM scoliosis treatment. This retro-active study remains unpublished because of a lack of independent review board oversight while the data was being collected, it does provide real and usable clinical data for evaluation and study. Here is a copy of the abstract from that 2010 study.

Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series on 140 patients with adolescent or adult idiopathic scoliosis.

BACKGROUND:Scoliosis is the presence of 1 or more lateral curves of the spine. Although defined as a side-to-side deformity, it involves all three dimensions. The majority of scoliosis cases have no known cause (idiopathic). There are bio mechanical & neuro-muscular aspects that contribute to the progression of idiopathic scoliosis.

RESULTS: After an average of 12.6 treatment sessions, the subjects demonstrated an average reduction in the Cobb angle of 12.7 degrees. 23 patients (16.4%) were no longer classified as having clinically-diagnosable scoliosis post-intervention.

Without and With Advanced Scoliosis Rehab Procedures

Ok, so this isn’t technically a “CLEAR Insititute complaint“, but it explains why the results some patients reported from 8 years ago are different from the current CLEAR Institute results patients are reporting now. As with any new advancements, trial and error, new ideas, and good old fashion hard work always leads to improved technology and best practices methodology. One phrase that is commonly uttered by CLEAR InstituteTM doctors is “Always reserve the right to get smarter”. The first significant “leap” forward made by the doctors of the CLEAR InstituteTM was the recongition that idiopathic scoliosis is primarily a neurological problem that has it’s primary effects on the spine. This is a fundamental shift from the traditional “Scoliosis is solely a spinal condition” mentality the orthopedic community has adopted for slow long and set the guiding philosophy for future innovation.

The next step in the CLEAR InstituteTM scoliosis treatment creation process was the “mix, fix, and set” protocol. Developed as a specialized treatment protocol for scoliosis, MIX, FIX, SET allowed not only for the stabilization of spinal curvatures, but the consistent reduction of scoliosis as well. Here is the basic premise. The soft tissue (spinal discs, ligaments, muscles, ect) slowly begin to adapt to the abnormal spinal position, essentially “locking” the scoliosis in place. It becomes necessary to “unlock” the spinal position from the mal-adapted soft tissue (MIX), so the spine can be repositioned (FIX), and finally the soft tissue can be re-trained (SET) to hold the spine in the new straighter position.

The spirit of innovation is still alive and well in the CLEAR InstituteTM and new, exciting scoliosis exercise/rehab break-throughs (like the ones pictured in the top right hand corner of this section) are still the norm, not the exception.

Scoliosis Exercises Are MANDATORY!

6. Patient compliance with the home rehabilitation program

The CLEAR InstituteTM scoliosis treatment program is based on an “active rehab effect”. Many of the “in treatment” re-evaluation/ “stress” studies (x-rays that are taken with the patient wearing the rehab equipment) are taken in a seated and/or neutral position approximately 10 min after an active training session, so it is a demonstration of the training effect, not a permanent and stabilized, corrected spinal position.

It is important to note that these “in treatment” and “stress” x-ray re-evaluations are based off an “active training effect” (as opposed to a passive/artificial treatment affect as with scoliosis bracing) which requires 4-6 months of repeated neuro-muscular training before the SAID (soft tissue adapts to imposed demands) principle can coordinate and stabilize the curve reduction seen on a cobb angle x-ray. In effect, the “active training effect” from the rehab is only apparent immediately following a rehab session until the postural control reflexes and muscles have appropriate time to adapt. Which, again, requires 4-6 months in most cases.

Metaphorically, it could be compared to climbing a very large mountain. Most climbers can climb up to a certain altitude before needing to establish a “base camp” to rest and let their bodies acclimate to the new altitude. After a few days, they are able to climb even higher, establish a new “base camp” and start the process all over again. That same logic can be applied to the CLEAR InstituteTM scoliosis treatment program. The curve is reduced to a certain level, but the patients body needs time (4-6 months) to set up a “base camp” to establish a “new normal” spine position neurologically and bio-mechanically. After that point, the patient can “re-engage” the scoliosis spine curve with another aggressive, non-invasive CLEAR InstituteTM scoliosis treatment session and “climb the mountain” a little higher before needing to establish a new “base camp”. This process can be repeated over and over again until the scoliosis curve is eliminated or permanent structural adaptations (disc and bone wedging) prevent further curve reduction.

This is particularly true in a case with a large amount of spinal flexibility. This is to suggest that a patient’s spinal curvature would show significant reduction immediately following a rehab session and the “training effect” would slowly diminish some time following that session and the curvature would regress back, however the “training effect” will become more and more permanent over the 4-6 month stabilization period with continued rehab session following the intensive care treatment.

Basically, a patients case may demonstrate an excellent response to the CLEAR InstituteTM scoliosis treatment protocol, but there simply may not have been enough time for the training effect to take hold and show a permanently reduced cobb angle. This is why we heavily stress the importance of continuing the home rehab program, but many parents and patients whom re-evaluate too early forget it probably hasn’t been implemented long enough to show improvement on x-ray a significant time after a rehab session…. yet.

Late Stage (Severe) Scoliosis Posture

Early Stage Scoliosis Intervention is the ideal scoliosis treatment scenario for maximum correction and highest success rates. Stay Ahead of the Curve.

7. Late stage (severe) scoliosis intervention

What do all LARGE scoliosis spine curvatures have in common?They all started out as small scoliosis spine curvatures. All too often, parents are “watching and waiting” until their child’s mild scoliosis curve gets worse and then putting all of their faith into scoliosis brace treatment that has been proven ineffective in study after study. Unfortunately, in a significant amount of idiopathic scoliosis cases, the curvature reaches the mythical 40+ degree “surgical threshold”.

Sadly, this is the first time many parents even start searching for a better way online and come across the CLEAR InstituteTM. In fact, many of you whom are reading this right now, probably have lived through a similar experience to the one I described above.

Ideally, ALL mild scoliosis cases would be properly identified through school scoliosis screenings, ScoliscoreTM genetically tested for pre-disposed risk of severe curve progression, and enrolled in the Early Stage Scoliosis InterventionTM program that re-trains the automatic postural control centers in the brain to “learn” how to hold the spine straighter, before the scoliosis curvature gains enormous bio-mechanical advantage and the patient experiences “postural collapse”. It pays to…….Stay ahead of the curveTM

Whist that being said, many of the patients seeking CLEAR InstituteTM scoliosis treatment are hoping for a scoliosis surgery alternative and with good reason. In 2002, A long-term follow-up study of post scoliosis surgery treated patients found that 40% of them were legally defined as severely handicapped and another study, a 50 year follow-up of “untreated” scoliosis patients, found they had a much higher quality of life than the scoliosis surgery treated patients in the previous study.

Unfortunately, common sense and reality tells us that smaller curves in younger patients tend to respond to scoliosis treatment (all scoliosis treatment except scoliosis surgery….which does worse) than larger curves in older patients. However, all is not lost and there is still abundant hope for late stage (severe) scoliosis patients to utilize the CLEAR InstituteTM scoliosis treatment program to avoid the need for highly invasive scoliosis surgery. In fact, the unpublished 2010 study conducted by several CLEAR InstituteTM doctors found that severe scoliosis patients were able to reduce their scoliosis spine curvatures by an average of 38%; which is consistent with the 30-50% scoliosis curve reductions anecdotaliy reported by CLEAR InstituteTM doctors over the years.

The unfortunate aspect of treating late stage/ severe scoliosis in this manner is that some cases will not suffiently respond to treatment and continue to progress due to the momentum of the postural collapse, some of the spinal deformity may be permanent, and the patient may have to continue home scoliosis exercises on a daily basis for the rest of their life to maintain their spinal health.

Typical Pre and Post CLEAR Institute Scoliosis Treatment Results

8. Realistic scoliosis treatment expectations

Scoliosis brace treatment is only intended to halt scoliosis spine progression and reduce the “need” for scoliosis surgery (both of which have been proven unaffected by scoliosis bracing in current research). Scoliosis surgery is NOT medically necessary and is only intended to “improve spinal deformity” and attempt to halt adulthood curve progression (both of which are currently being contested in recent studies). Which bring up the question; Is the cure worse than the condition?

Something needs to be done, but what? No one in the CLEAR InstituteTM is suggesting that not treating scoliosis is the correct course of action, but the very poor scoliosis treatment success rates being reported by the traditional scoliosis treatment community warrants a new and fresh look at the problem.

Idiopathic is a chronic, progressive condition and the current “gold standard” in treatment is simply halting the progression.Non-surgical curve reduction in late stage (severe) scoliosis has simply been unheard of on a consistent basis until recently, so it may be time to start re-defining “success in scoliosis treatment”. Unfortunately, change is slow and traditions/beliefs often run deep, so the current clinical model for scoliosis treatment success with in the CLEAR InstituteTM scoliosis treatment model looks something like this…..

Halt Progression

Reduce Existing Deformity/Curvature

Permanently Stabilize Corrections

Create Customized Home Care Plan

***Note: It is important to recognize that scoliosis spine curvatures 30 degrees and larger display abnormal rotation patterns in the thoracic spine (mid back) that increase the amount of spine deformity and likelihood of curve progression. Additional treatment, time, effort, and specific scoliosis exercise equipment (scoliosis traction chair) may be necessary in these cases.

The actual amount of scoliosis curve reduction a patient can achieve highly variable from case to case and dependent on many known (and unknown) factors like: age of the patient, size of curvature, spinal curve flexibility, patient compliance, patient effort, ect.

On average, patients can expect a 30-50% reduction in their scoliosis spine curvature over the course of a CLEAR InstituteTM scoliosis treatment program.